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When to use 36550

APCs Weekly Monitor, September 3, 2004

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QUESTION: I noticed the last issue of APCs Weekly Monitor stated that declotting of a peripherally inserted central venous catheter (PICC) line is only reportable via an E/M. Could you give an example of when you would use CPT 36550, declotting by thrombolytic agent of implanted vascular access device or catheter?

ANSWER: CPT code 36550, declotting by thrombolytic agent of implanted vascular access device or catheter, is to be used for declotting of a completely implanted or partially implanted central venous access device.

All portions of a completely implanted device are located beneath the skin (i.e., catheter and port) as opposed to partially implantable, in which the external access site(s) travel beneath the skin before entering the vein.

Partially implanted catheters (CPT codes 36557-36566) are distinguished from peripherally inserted central venous catheter (PICC) insertion (36568 and 36569) by the technique required to create the "tunnel," in which the intracutaneous portion of the catheter lies. During the insertion of a partially implantable catheter, creating the tunnel requires a specific and separate surgical step, not simply a skin incision with tract dilation.

Therefore, based upon the definitions listed above, a PICC line insertion would not qualify as a completely implantable or partially implantable central venous access device. Refer to CPT Assistant February 1999 and November 1999 for further details.

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